They got into medical school, but the uphill journey continues for first-gen college graduates

Illustration of someone walking up stairs with a large book
(Illustration by Anna Parini)

Higher education, especially when it comes to law and medicine, is thought of as an equalizer, propelling individuals from under-resourced backgrounds to an upper echelon of society. But in recent years, it has become increasingly clear that first-generation (first-gen) college students continue to face specific challenges as they progress in academia. Despite the grit, resilience and intrinsic motivation that first-gen students display in order to succeed in higher education, there are persistent systemic factors that keep them from fully thriving in these settings.  

In essence, the idea of higher education as “the great equalizer” has been a myth. And yet, little attention is typically paid to first-gen students, especially once they are in prestigious graduate programs (like medical school), the assumption being that because they were able to graduate from college, they must have “made it.” 

In a study involving students at 27 medical schools around the country that colleagues and I published at the end of last year, we revealed empirical qualitative evidence of the barriers that first-gen college graduates experience in medical school. After analyzing these barriers, four major themes emerged: 

  • Isolation and exclusion 
  • Challenges with access to resources 
  • Lack of institutional support 
  • Need to rely on grit and resilience to survive 

The added challenge is that despite succeeding in higher education, the farther up the ladder these students move, the more the community of fellow first-gen college graduates shrinks. I know this on a personal level from my own experience as a first-generation college graduate, and this paradox is corroborated by the narratives of current first-gen college graduates in medical school in this study. 

It also has been validated by earlier research, such as a 2023 study by UCLA Health and David Geffen School of Medicine at UCLA researchers that found that Black, Hispanic and Native American students who took the Medical College Admission Test (MCAT) were ultimately less likely to actually apply to medical school due to a range of barriers, one of them being having parents without a college degree. 

It wasn’t until recent years that this dynamic began to gain recognition and awareness, and support began growing for first-gen college graduates in medical school. After I joined the faculty of the David Geffen School of Medicine at UCLA in 2016, I started to mentor first-gen medical students, and in their stories I heard my own being reflected back at me. I remembered how I felt throughout my academic training — isolated, like an outsider.  

My parents are amazing people, and they are my role models, but they did not have an education beyond the sixth grade. I was not equipped with the socio-cultural capital that likely plays a part in the life experiences of many of the folks we perceive as successful, or that allows people from higher socioeconomic statuses certain privileges or entry into unique educational opportunities. 

And I remember feeling that my sense of isolation meant I was deficient in some way. There was no word or term to name this experience; “first-gen” wasn’t something that was much talked about back then, and if it was, there was a stigma attached to it. 

But now, as a faculty member at one of the nation’s most prestigious medical schools, I have an opportunity to do something about it. In 2017, in partnership with “FirstToGo,” a UCLA program for undergraduates, I hosted, with support of our dean’s office, an event for first-gen UCLA medical students to assess their interest in forming a community to support first-gen college graduates in medicine. We thought it would be a small lunch session, but it ultimately evolved into an emotional event attended by close to 200 students from across all class years. As we launched into a discussion about being first-gen at the medical school, all this rich detail and threads came out — along with tears. 

Whatever it is in your life that has fueled you, bring it with you as you move forward. Don’t hide or sacrifice part of yourself to "make it.” bring It all with you.

From that, the medical school’s “First Gen” organization was born. I am grateful we can now name the experience for our first-gen community, and instead of feeling stigma, show that our struggles and life experiences are a picture of empowerment and persistence. I remind my students that their first-gen identity will be a gift for their future patients. Today, a sizable percentage of students entering medical school at UCLA are first generation, and we’ve gained a significant national reputation and have built supportive resources and community for our first-gen students. Now, we want to expand this effort across all strata in our health system community — not just for students, but also for staff, trainees and faculty. Places of higher learning and the academic ivory tower weren’t originally built for people like us. We must find ways for our institutions to embrace our rich life trajectories. 

I think one of my fears growing up was of “making it” and having to leave my past behind. A bit of that, I think, has been instilled in many people in our community. We absorb images of what it means to be successful, and these don’t necessarily encompass the way we grew up — being low income, having social challenges. We absorb the mantra: To succeed, get educated and become a different person. But I learned that for me, to succeed meant I had the freedom to express my full self. This I also tell my students: Whatever it is in your life that has fueled you, bring it with you as you move forward. Don’t hide or sacrifice part of yourself to “make it.” Bring it all with you. 

How do we ensure that our first-gen college graduates in medicine feel not only that they are a part of this great institution, but also that they are celebrated? So that they bring their “full selves” with them? It is wonderful that more first-gen individuals make up the UCLA community, but our support systems and academic climate must continue to evolve. That is where the importance of evidence, like that from our study, comes in, so we continue to shift our academic institutions and health systems in a more equitable, diverse and inclusive direction.  

Dr. Alejandra Casillas is an assistant professor-in-residence of medicine and health services research.  

Take the Next Step

To read a Q&A in U Magazine with UCLA Health researchers about their study of obstacles hindering aspiring medical students, go here

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